New student in ICU/CCU

nurse04girl · Apr 24, 2006

Take a deep breath! You are not on a downward spiral. IT IS NURSING SCHOOL!!!! We have all been there. You should be aware of the alarms on the ventilator. Not all ventilator setting totally breath for the patient. Get out that mountain of nursing books that you carry around and read... Learn the gtts used on the unit. There should be a pharmacy protocol book on the unit. You should be able to go to the protocol and get all the information about a certain gtt you should need. It may be a computer based program. Critical care websites are also full of information. Do you get your patient prior to clinical? Go on the unit and look at the chart. When I was in school, we would go to the unit and look at the chart. We were allowed as long as we had on our lab coats with our school name on them and our ID. I think you will see a difference the next clinical day.

papawjohn · Apr 24, 2006

Hey Luv!!!

First of all--let your fear and anxiety be in relation to your responsibility. OK? Not being a smart@ss at all!!! Just an observation that very high levels of anxiety will block learning. And you are there to learn. So you must begin by dealing with your fears.

I tell family members and others not used to the ICU sights and sounds: "Don't be nervous until I look nervous, OK?" And that's prob'ly good advice for you--don't get nervous until the RNs around the unit start yelling and all head the same way at once!!!

Then, with great composure and inner peace (), remember that somewhere inside that mass of machinery and wiring and plumbing there is a Patient who is a human being like you.

Start by thinking of the Patient with ARDs. What's with him? Most of those folks require a fair amount of sedation. With sedation should go reassurance and FlorenceNightingale-type TLC. He should be resting--partially because it lowers his body's Oxygen requirements and partially because it keeps him from working against the vent. (And partially because it seems kind and humane.)

You should find a way to stand near him and touch him, look him over--'assess' him. Same as any assessment: Does he rouse? Neuro deficits? Breathing with difficulty? Stethoscope reveals air travelling thru the airways? Abdomen soft? Pulses in the extremities? Color? Skin warm?

You can do all that. You know you've done it before--so start with what you know.

You're doing great!!!

Now, step back from the Pt and lean back against the wall and (again--with great peace of mind) look at how all the monitors and machinery relate to the things that were in your assessment. His sedation level is hinted at in the heartrate on the screen. His Pulse Ox can be incorporated into the 'Resp' and 'Skin' sections of the assessment.

Now look at the machinery. The Vent has been set by Dr's orders based on ABGs and the Pt's clinical status. You don't need to know much about it right now--but a clever and inquisative amatuer like yourself would see on the Vent a couple of things. Like--how much Oxygen is the Pt getting? (Since you and I get along on 21% just fine--you can kinda see how sick the poor Pt is by knowing how much O2 he requires.) What is the resp rate? That gives you some information about how hard the Vent and Pt have to work to get Oxygen into his blood.

Now--it's time to think of what are we going to DO for this poor soul. You have to start planning for Meds and Treatments and making a schedule and a sense of priorities: Has he had a Chest XR? Is he being fed? Are Labs back? Are we going to try to wean the Vent today?

All that is going to become your profession some day. It's not rocket science but it does require clear thinking.

Hope that helps

Papaw John

mom2michael, MSN, RN, NP · Apr 26, 2006

On my 1st day of nursing school clinicals in the ICU I was freaked out by all the machines hooked up to what appeared to be a woman underneath it all. The nurse with me that day was awesome and she said, stand here and look at each machine one by one. Don't look at the big picture, look at the smaller pictures. So we went around the room and I figured out what each machine was, what it's purpose was and what I (as a student) needed to know about that machine for the day. After that was done, seeing the patient under the machines was a breeze.

I work as a student nurse tech in PCCU/MICU/SICU and the #1 complaint I hear from the nurses I work with is that students come into the unit and just sit all day and don't ask questions or they pretend they already know what they are doing and they don't ask questions. They are fully aware that students are there to learn and 99.9% of the nurses I work with want to teach, but they will not teach an unwilling student with no desire to learn. So ask away because they are and they will be your best resource for learning while you are in the ICU.

Now, take a big deep breath and enjoy your ICU clinicals. You will learn so much while you are there.